BACKGROUND: Guidelines for breast cancer patient follow-up have not been widely adopted in Japan. To assess our intensive follow-up program, we evaluated first relapse and its indicators in patients with breast cancer. PATIENTS: Of 964 patients, 126 relapsed and 43 died in the median follow-up term of 45 months. Follow-ups were scheduled every 6-12 months for imaging and tumor marker (TM) evaluation. RESULTS: Of 126 relapsed patients, 30 (23.8%) had symptoms of relapse. First indicators of relapse in 96 asymptomatic patients were physical examination in 24 patients (19%); imaging, 57 patients (45.3%); and TMs, 15 patients (11.9%). The most sensitive indicators were physical examination for local relapse, ultrasonography for regional lymph nodes, scintigraphy for bone, computed tomography for lung, and TMs for liver metastasis. During intensive follow-up, 43% of relapsed patients were identified by symptoms or physical examination. These patients had poor prognosis compare to patients identified by imaging or TMs in overall survival and post-relapse survival (p = 0.009 and 0.019, respectively). In all 964 patients, the relapse rates for stage I, IIA, IIB, and III tumors were 7.4, 7.9, 19.9, and 43.5%, respectively. The percentage of first relapse detected by imaging or TMs for stage I, IIA, IIB, and III were 4.7, 5.1, 11.8, and 19.8%, respectively. The cost of our follow-up program for 10 years was approximately 290,000 yen per patient. CONCLUSION: A routine intensive follow-up program involving imaging and evaluation of TMs in all patients has low efficacy and high expenditure.
BACKGROUND: Guidelines for breast cancerpatient follow-up have not been widely adopted in Japan. To assess our intensive follow-up program, we evaluated first relapse and its indicators in patients with breast cancer. PATIENTS: Of 964 patients, 126 relapsed and 43 died in the median follow-up term of 45 months. Follow-ups were scheduled every 6-12 months for imaging and tumor marker (TM) evaluation. RESULTS: Of 126 relapsed patients, 30 (23.8%) had symptoms of relapse. First indicators of relapse in 96 asymptomatic patients were physical examination in 24 patients (19%); imaging, 57 patients (45.3%); and TMs, 15 patients (11.9%). The most sensitive indicators were physical examination for local relapse, ultrasonography for regional lymph nodes, scintigraphy for bone, computed tomography for lung, and TMs for liver metastasis. During intensive follow-up, 43% of relapsed patients were identified by symptoms or physical examination. These patients had poor prognosis compare to patients identified by imaging or TMs in overall survival and post-relapse survival (p = 0.009 and 0.019, respectively). In all 964 patients, the relapse rates for stage I, IIA, IIB, and III tumors were 7.4, 7.9, 19.9, and 43.5%, respectively. The percentage of first relapse detected by imaging or TMs for stage I, IIA, IIB, and III were 4.7, 5.1, 11.8, and 19.8%, respectively. The cost of our follow-up program for 10 years was approximately 290,000 yen per patient. CONCLUSION: A routine intensive follow-up program involving imaging and evaluation of TMs in all patients has low efficacy and high expenditure.
Authors: Gregory S Cooper; Christine Cole Johnson; Lois Lamerato; Laila M Poisson; Lonni Schultz; Jan Simpkins; Karen Wells; Marianne Ulcickas Yood; Gary Chase; S David Nathanson; Jennifer Elston Lafata Journal: Med Care Date: 2006-06 Impact factor: 2.983
Authors: M Pennant; Y Takwoingi; L Pennant; C Davenport; A Fry-Smith; A Eisinga; L Andronis; T Arvanitis; J Deeks; C Hyde Journal: Health Technol Assess Date: 2010-10 Impact factor: 4.014
Authors: James L Khatcheressian; Antonio C Wolff; Thomas J Smith; Eva Grunfeld; Hyman B Muss; Victor G Vogel; Francine Halberg; Mark R Somerfield; Nancy E Davidson Journal: J Clin Oncol Date: 2006-10-10 Impact factor: 44.544
Authors: Marcel Smid; Yixin Wang; Yi Zhang; Anieta M Sieuwerts; Jack Yu; Jan G M Klijn; John A Foekens; John W M Martens Journal: Cancer Res Date: 2008-05-01 Impact factor: 12.701
Authors: E M Jung; D A Clevert; A G Schreyer; S Schmitt; J Rennert; R Kubale; S Feuerbach; F Jung Journal: World J Gastroenterol Date: 2007-12-21 Impact factor: 5.742